Provider Demographics
NPI:1346065364
Name:BREM, OLIVIA MARIE (OTD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:BREM
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:MARIE
Other - Last Name:HOSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 REASONS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8696
Mailing Address - Country:US
Mailing Address - Phone:719-488-9221
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist